Healthcare Provider Details

I. General information

NPI: 1750792636
Provider Name (Legal Business Name): DORENE GERALDINE VELIKY APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS DORENE GERALDINE BALASA

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GARDEN STATE PLZ STE 1170
PARAMUS NJ
07652-2417
US

IV. Provider business mailing address

718 TEANECK RD
TEANECK NJ
07666-4245
US

V. Phone/Fax

Practice location:
  • Phone: 201-270-4588
  • Fax: 201-270-4589
Mailing address:
  • Phone: 201-833-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00498500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: